Adherence to PALS Sepsis Guidelines and Hospital Length of Stay
- 1 August 2012
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 130 (2), e273-e280
- https://doi.org/10.1542/peds.2012-0094
Abstract
BACKGROUND AND OBJECTIVES: Few studies have evaluated sepsis guideline adherence in a tertiary pediatric emergency department setting. We sought to evaluate (1) adherence to 2006 Pediatric Advanced Life Support guidelines for severe sepsis and septic shock (SS), (2) barriers to adherence, and (3) hospital length of stay (LOS) contingent on guideline adherence. METHODS: Prospective cohort study of children presenting to a large urban academic pediatric emergency department with SS. Adherence to 5 algorithmic time-specific goals was reviewed: early recognition of SS, obtaining vascular access, administering intravenous fluids, delivery of vasopressors for fluid refractory shock, and antibiotic administration. Adherence to each time-defined goal and adherence to all 5 components as a bundle were reviewed. A detailed electronic medical record analysis evaluated adherence barriers. The association between guideline adherence and hospital LOS was evaluated by using multivariate negative binomial regression. RESULTS: A total of 126 patients had severe sepsis (14%) or septic shock (86%). The median age was 9 years (interquartile range, 3–16). There was a 37% and 35% adherence rate to fluid and inotrope guidelines, respectively. Nineteen percent adhered to the 5-component bundle. Patients who received 60 mL/kg of intravenous fluids within 60 minutes had a 57% shorter hospital LOS (P = .039) than children who did not. Complete bundle adherence resulted in a 57% shorter hospital LOS (P = .009). CONCLUSIONS: Overall adherence to Pediatric Advanced Life Support sepsis guidelines was low; however, when patients were managed within the guideline’s recommendations, patients had significantly shorter duration of hospitalization.Keywords
This publication has 16 references indexed in Scilit:
- Part 14: Pediatric Advanced Life SupportCirculation, 2010
- Mortality and Functional Morbidity After Use of PALS/APLS by Community PhysiciansPEDIATRICS, 2009
- Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine*Critical Care Medicine, 2009
- Advances in the emergency management of pediatric sepsisCurrent Opinion in Pediatrics, 2006
- Pediatric considerationsCritical Care Medicine, 2004
- Early Reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is Associated With Improved OutcomePEDIATRICS, 2003
- Pediatric septic shock and multiple organ failureCritical Care Clinics, 2003
- The Epidemiology of Severe Sepsis in Children in the United StatesAmerican Journal of Respiratory and Critical Care Medicine, 2003
- Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock*Critical Care Medicine, 2002
- Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic ShockThe New England Journal of Medicine, 2001